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To investigate the pandemic's impact on critically ill patients with neurological emergencies, we compared care metrics and outcomes of patients with severe acute brain injury (SABI) before and during the initial COVID-19 surge at our institution. We included adult patients with SABI during two separate three-month time periods: 'pre-COVID vs COVID'. We further stratified the COVID cohort to characterize outcomes in patients requiring COVID-19 precautions (Patient Under Investigation, 'PUI'). The primary endpoint was in-hospital mortality; secondary endpoints included length of stay (LOS), diagnostic studies performed, time to emergent decompressive craniectomies (DCHC), ventilator management, and end-of-life care. We included 394 patients and found the overall number of admissions for SABI declined by 29 % during COVID (pre-COVID n = 231 vs COVID, n = 163). Our primary outcome of mortality and most secondary outcomes were similar between study periods. There were more frequent extubation attempts (72.1 % vs 76 %) and the mean time to extubation was shorter during COVID (55.5 h vs 38.2 h). The ICU LOS (6.10 days vs 4.69 days) and hospital LOS (15.32 days vs 11.74 days) was shorter during COVID. More PUIs died than non-PUIs (51.7 % vs 11.2 %), but when adjusted for markers of illness severity, this was not significant. We demonstrate the ability to maintain a consistent care delivery for patients with SABI during the pandemic at our institution. PUIs represent a population with higher illness severity at risk for delays in care. Multicenter, longitudinal studies are needed to explore the impact of the pandemic on patients with acute neurological emergencies.

Few guidelines have focused on the care delivered after return of spontaneous circulation (ROSC). Post ROSC best practice guidelines lack clarity about important tasks to accomplish in the first hours after ROSC.We conducted a retrospective cohort analysis of adults who had suffered an in hospital cardiac arrest (IHCA) with ROSC over a two-year period to determine the completion rate of critical tasks in the immediate post-ROSC period: ECG within one hour, ABG within one hour, physician documentation within six hours, and surrogate communication within six hours.In the 113 reviewed cases, there was significant variance between completion of all four (19.4%), three (35.3%), two (32.7%), one (20.6%) and none (1.7%) of these critical post ROSC tasks. We observed that 62.8% of IHCA with ROSC had an ECG obtained within one hour of ROSC. The rate of obtaining an ABG within one hour of ROSC was 76.9%. 49.5% of cases had physician documentation of the resuscitation within six hours of ROSC. The rate of documenting surrogate communication within six hours of ROSC was 69.9%.Our study demonstrated that the completion rates of critical tasks in the post ROSC setting were suboptimal within our patient cohort. This provides a baseline for the development of future best practice guidelines and clinical decision-making aids for post ROSC care after IHCA. This can lead to future research in coupling specific care tasks to post ROSC patient outcomes.

Background Despite the growing role of simulation in procedural teaching, bronchoscopy training largely is experiential and occurs during patient care. The Accreditation Council for Graduate Medical Education sets a target of 100 bronchoscopies to be performed during pulmonary fellowship. Attending physicians must balance fellow autonomy with patient safety during these clinical teaching experiences. Few data on best practices for bronchoscopy teaching exist, and a better understanding of how bronchoscopy currently is supervised could allow for improvement in bronchoscopy teaching. Research Question How do attending bronchoscopists supervise bronchoscopy, and in particular, how do attendings balance fellow autonomy with patient safety? Study Design and Methods This was a focused ethnography conducted at a single center using audio recording of dialog between attendings and fellows during bronchoscopies, supplemented by observation of nonverbal teaching. Interviews with attending bronchoscopists and limited interviews of fellows also were recorded. Interviews were transcribed verbatim before analysis. We used constant comparative analysis to analyze data and qualitative research software to support data organization and thematic analysis. Education researchers from outside of pulmonary critical care joined the team to minimize bias. Results We observed seven attending bronchoscopists supervising eight bronchoscopies. We noted distinct teaching behaviors, classified into themes, which then were grouped into four supervisory styles of modelling, coaching, scaffolding, and fading. Observation and interviews illuminated that assessing fellow skill was one tool used to choose a style, and attendings moved between styles. Attendings accepted some, but not all, variation in both performing and supervising bronchoscopy. Interpretation Attending pulmonologists used a range of teaching microskills as they moved between different supervisory styles and selectively accepted variation in practice. These distinct approaches may create well-rounded bronchoscopists by the end of fellowship training and should be studied further.

Post modification of biodegradable polyesters as biodegradable dispersants.

The objective of this study is to describe incidence and factors associated with early withdrawal of life-sustaining therapies based on presumed poor neurologic prognosis (WLST-N) and practices around multimodal prognostication after out-of-hospital cardiac arrest (OHCA).We performed a subanalysis of a randomized controlled trial assessing prehospital therapeutic hypothermia in adult patients admitted to nine hospitals in King County with nontraumatic OHCA between 2007 and 2012. Patients who underwent tracheal intubation and were unconscious following return of spontaneous circulation were included. Our outcomes were (1) incidence of early WLST-N (WLST-N within 72 h from return of spontaneous circulation), (2) factors associated with early WLST-N compared with patients who remained comatose at 72 h without WLST-N, (3) institutional variation in early WLST-N, (4) use of multimodal prognostication, and (5) use of sedative medications in patients with early WLST-N. Analysis included descriptive statistics and multivariable logistic regression.We included 1,040 patients (mean age was 65 years, 37% were female, 41% were White, and 44% presented with arrest due to ventricular fibrillation) admitted to nine hospitals. Early WLST-N accounted for 24% (n = 154) of patient deaths and occurred in half (51%) of patients with WLST-N. Factors associated with early WLST-N in multivariate regressions were older age (odds ratio [OR] 1.02, 95% confidence interval [CI]: 1.01-1.03), preexisting do-not-attempt-resuscitation orders (OR 4.67, 95% CI: 1.55-14.01), bilateral absent pupillary reflexes (OR 2.4, 95% CI: 1.42-4.10), and lack of neurological consultation (OR 2.60, 95% CI: 1.52-4.46). The proportion of patients with early WLST-N among all OHCA admissions ranged from 19-60% between institutions. A head computed tomography scan was obtained in 54% (n = 84) of patients with early WLST-N; 22% (n = 34) and 5% (n = 8) underwent ≥ 1 and ≥ 2 additional prognostic tests, respectively. Prognostic tests were more frequently performed when neurological consultation occurred. Most patients received sedating medications (90%) within 24 h before early WLST-N; the median time from last sedation to early WLST-N was 4.2 h (interquartile range 0.4-15).Nearly one quarter of deaths after OHCA were due to early WLST-N. The presence of concerning neurological examination findings appeared to impact early WLST-N decisions, even though these are not fully reliable in this time frame. Lack of neurological consultation was associated with early WLST-N and resulted in underuse of guideline-concordant multimodal prognostication. Sedating medications were often coadministered prior to early WLST-N and may have further confounded the neurological examination. Standardizing prognostication, restricting early WLST-N, and a multidisciplinary approach including neurological consultation might improve outcomes after OHCA.

Case Presentation A 57-year-old man who had been intubated and placed on venovenous extracorporeal membrane oxygenation for hypoxemic respiratory failure due to COVID-19 pneumonia was transferred to our facility. He underwent anticoagulation with IV heparin titrated to an anti-Factor Xa goal of 0.1 to 0.3 international unit/mL. Over extracorporeal membrane oxygenation days 13 to 17, his WBC count rose from 17,500 to 47,000 cells/μL. He simultaneously experienced the development of fluid-refractory shock that required multiple vasopressors and received stress-dose hydrocortisone when his WBC was 30,000 cells/μL. He remained afebrile and was started on broad-spectrum antimicrobials that included antifungal and anthelminthic therapy.

Rationale: No direct comparisons of clinical features, laboratory values, and outcomes between critically ill patients with coronavirus disease (COVID-19) and patients with influenza in the United ...

To summarize pathophysiology, key conflicts, and therapeutic approaches in managing concomitant severe acute brain injury (SABI) and acute respiratory distress syndrome (ARDS).ARDS is common in SABI and independently associated with worse outcomes in all SABI subtypes. Most landmark ARDS trials excluded patients with SABI, and evidence to guide decisions is limited in this population. Potential areas of conflict in the management of patients with both SABI and ARDS are (1) risk of intracranial pressure (ICP) elevation with high levels of positive end-expiratory pressure (PEEP), permissive hypercapnia due to lung protective ventilation (LPV), or prone ventilation; (2) balancing a conservative fluid management strategy with ensuring adequate cerebral perfusion, particularly in patients with symptomatic vasospasm or impaired cerebrovascular blood flow; and (3) uncertainty about the benefit and harm of corticosteroids in this population, with a mortality benefit in ARDS, increased mortality shown in TBI, and conflicting data in other SABI subtypes. Also, the widely adapted partial pressure of oxygen (PThe management of SABI with ARDS is highly complex, and conventional ARDS management strategies may result in increased ICP and decreased cerebral perfusion. A crucial aspect of concurrent management is to recognize the risk of secondary brain injury in the individual patient, monitor with vigilance, and adjust management during critical time windows. The care of these patients requires meticulous attention to oxygenation and ventilation, hemodynamics, temperature management, and the neurological exam. LPV and prone ventilation should be utilized, and supplemented with invasive ICP monitoring if there is concern for cerebral edema and increased ICP. PEEP titration should be deliberate, involving measures of hemodynamic, pulmonary, and brain physiology. Serial volume status assessments should be performed in SABI and ARDS, and fluid management should be individualized based on measures of brain perfusion, the neurological exam, and cardiopulmonary status. More research is needed to define risks and benefits in corticosteroids in this population.

Purpose We sought to understand current POCUS practices and comfort as well as assess opinions about POCUS across our medical system via a survey to guide program development. Methods This study was conducted as a 19 question RedCap survey with multiple parts. Respondents were queried for demographics as well as experience with, attitudes toward, and clinical use of POCUS in common critical care scenarios. Results The survey was completed by 343 individuals, a response rate of 30%. Most respondents "agreed" that POCUS is a needed skill and helped them provide safer care (78% and 86% agreement). Most faculty and trainees reported some POCUS training (62% and 88%) and at least weekly use. Trainees rated themselves more comfortable than faculty for most exam types. The majority of faculty rated their POCUS education as inadequate while trainees had mixed responses. Conclusions POCUS is a frequently used tool, yet users are less confident in their skills than expected. POCUS applications are viewed as needed for future practice but there is a substantial need for improved education among faculty and trainees. Pooling resources and sharing educational initiatives across multiple specialties may help improve POCUS implementation.

Correction for ‘Microphase separation of highly amphiphilic, low N polymers by photoinduced copper-mediated polymerization, achieving sub-2 nm domains at half-pitch’ by Ellis Hancox et al., Polym. Chem., 2019, 10, 6254–6259. DOI: 10.1039/c9py01312a.

The air tolerant precatalyst, [Rh(L)(NBD)]Cl ([1]Cl) [L = κ3-(iPr2PCH2CH2)2NH, NBD = norbornadiene], mediates the selective synthesis of N-methylpolyaminoborane, (H2BNMeH)n, by dehydropolymerization of H3B·NMeH2. Kinetic, speciation, and DFT studies show an induction period in which the active catalyst, Rh(L)H3 (3), forms, which sits as an outer-sphere adduct 3·H3BNMeH2 as the resting state. At the end of catalysis, dormant Rh(L)H2Cl (2) is formed. Reaction of 2 with H3B·NMeH2 returns 3, alongside the proposed formation of boronium [H2B(NMeH2)2]Cl. Aided by isotopic labeling, Eyring analysis, and DFT calculations, a mechanism is proposed in which the cooperative “PNHP” ligand templates dehydrogenation, releasing H2B═NMeH (ΔG‡calc = 19.6 kcal mol–1). H2B═NMeH is proposed to undergo rapid, low barrier, head-to-tail chain propagation for which 3 is the catalyst/initiator. A high molecular weight polymer is formed that is relatively insensitive to catalyst loading (Mn ∼71 000 g mol–1; Đ, of ∼ 1.6). The molecular weight can be controlled using [H2B(NMe2H)2]Cl as a chain transfer agent, Mn = 37 900–78 100 g mol–1. This polymerization is suggested to arise from an ensemble of processes (catalyst speciation, dehydrogenation, propagation, chain transfer) that are geared around the concentration of H3B·NMeH2. TGA and DSC thermal analysis of polymer produced on scale (10 g, 0.01 mol % [1]Cl) show a processing window that allows for melt extrusion of polyaminoborane strands, as well as hot pressing, drop casting, and electrospray deposition. By variation of conditions in the latter, smooth or porous microstructured films or spherical polyaminoboranes beads (∼100 nm) result.

Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs.Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among health care providers (HCPs) during COVID-19 surges in Brazil?We electronically administered a survey to multidisciplinary ICU HCPs during two 2-week periods (in June 2020 and March 2021) coinciding with COVID-19 surges. We examined responses across geographical regions and performed multivariate regressions to explore factors associated with reports of: (1) families being allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19 and (2) emotional distress and burnout.We included 1,985 respondents (57% physicians, 14% nurses, 12% respiratory therapists, 16% other HCPs). More respondents reported shortages during the second surge compared with the first (P .05 for all comparisons), including lower availability of intensivists (66% vs 42%), ICU nurses (53% vs 36%), ICU beds (68% vs 22%), and ventilators for patients with COVID-19 (80% vs 70%); shortages were highest in the North. One-quarter of HCPs reported that families were allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19, which was associated with lack of intensivists (adjusted relative risk [aRR], 1.37; 95% CI, 1.05-1.80) and ICU beds (aRR, 1.71; 95% CI, 1.16-2.62) during the first surge and lack of N95 masks (aRR, 1.43; 95% CI, 1.10-1.85), noninvasive positive pressure ventilation (aRR, 1.56; 95% CI, 1.18-2.07), and oxygen concentrators (aRR, 1.50; 95% CI, 1.13-2.00) during the second surge. Burnout was higher during the second surge (60% vs 71%; P .001), associated with witnessing colleagues at one's hospital contract COVID-19 during both surges (aRR, 1.55 [95% CI, 1.25-1.93] and 1.31 [95% CI, 1.11-1.55], respectively), as well as worries about finances (aRR, 1.28; 95% CI, 1.02-1.61) and lack of ICU nurses (aRR, 1.25; 95% CI, 1.02-1.53) during the first surge.During the COVID-19 pandemic, ICU HCPs in Brazil experienced substantial resource shortages, health care disparities between regions, changes in end-of-life care associated with resource shortages, and high proportions of burnout.

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) often develop acute hypoxemic respiratory failure and receive invasive mechanical ventilation. Much remains unknown about their respiratory mechanics, including the trajectories of pulmonary compliance and [Formula: see text] / [Formula: see text] , the prognostic value of these parameters, and the effects of prone positioning. We described respiratory mechanics among subjects with COVID-19 who were intubated during the first month of hospitalization. METHODS: We included patients with COVID-19 who were mechanically ventilated between February and May 2020. Daily values of pulmonary compliance, [Formula: see text] , [Formula: see text] , and the use of prone positioning were abstracted from electronic medical records. The trends were analyzed separately over days 1–10 and days 1–35 of intubation, stratified by prone positioning use, survival, and initial [Formula: see text] / [Formula: see text]. RESULTS: Among 49 subjects on mechanical ventilation day 1, the mean compliance was 41 mL/cm H(2)O, decreasing to 25 mL/cm H(2)O by day 14, the median duration of mechanical ventilation. In contrast, the [Formula: see text] / [Formula: see text] on day 1 was similar to day 14. The overall mean compliance was greater among the non-survivors versus the survivors (27 mL/cm H(2)O vs 24 mL/cm H(2)O; P = .005), whereas [Formula: see text] / [Formula: see text] was higher among the survivors versus the non-survivors over days 1–10 (159 mm Hg vs 138 mm Hg; P = .002) and days 1–35 (175 mm Hg vs 153 mm Hg; P < .001). The subjects who underwent early prone positioning had lower compliance during days 1–10 (27 mL/cm H(2)O vs 33 mL/cm H(2)O; P < .001) and lower [Formula: see text] / [Formula: see text] values over days 1–10 (139.9 mm Hg vs 167.4 mm Hg; P < .001) versus those who did not undergo prone positioning. After day 21 of hospitalization, the average compliance of the subjects who had early prone positioning surpassed that of the subjects who did not have prone positioning. CONCLUSIONS: Respiratory mechanics of the subjects with COVID-19 who were on mechanical ventilation were characterized by persistently low respiratory system compliance and [Formula: see text] / [Formula: see text] , similar to ARDS due to other etiologies. The [Formula: see text] / [Formula: see text] was more tightly associated with mortality than with compliance.

Background: COVID-19 has a widely variable clinical syndrome that is difficult to distinguish from bacterial sepsis, leading to high rates of antibiotic use. Early studies indicate low rates of secondary bacterial infections (SBIs) but have included heterogeneous patient populations. Here, we catalogue all SBIs and antibiotic prescription practices in a population of mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS requiring mechanical ventilation from 3 Seattle, Washington hospitals in 2020. Data were obtained via electronic and manual review of the electronic medical record. We report the incidence and site of SBIs, mortality, and antibiotics per day using descriptive statistics. Results: We identified 126 patients with COVID-19 induced ARDS during the study period. Of these patients, 61% developed clinical infection confirmed by bacterial culture. Ventilator associated pneumonia was confirmed in 55% of patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%. Staphylococcus aureus was the most commonly isolated bacterial species. A total of 97% of patients received antibiotics during their hospitalization, and patients received nearly one antibiotic per day during their hospital stay. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk for secondary bacterial infections and have extensive antibiotic exposure.

Copper-mediated reversible deactivation radical polymeriation (Cu-RDRP) in aqueous media has been employed to synthesize temperature-responsive block copolymers, utilizing both hydrophobic and hydrophilic amide functional macroinitiators derived from polyetheramines (Jeffamines™). The in situ and rapid diproportionation of Cu(I)Br/Me6TREN in water is exploited for the efficient homopolymerization of N-isopropyl acrylamide (NIPAM) and dimethyl acrylamide (DMA), at near full conversions (>99%), with low dispersity (Đ < 1.18) and with a range of molar masses. The Jeffamine™-derived macroinitiators were used for both the synthesis of homopolymer and for one-pot chain extensions and block copolymerizations (i.e. Jeffamine™-PNIPAM-b-PDMA). The obtained polymers exhibit controlled thermoresponsive aggregation behaviour which varies depending on the hydrophilicity/hydrophobicity of the macroinitiators and the composition of the block copolymers. Thermal analysis and dynamic light scattering (DLS) give an insight into the effect of these macroinitiators on the thermoresponsive aggregation behaviour of the synthesized polymers.

We present a systematic study of incorporating carboxyl groups into latex particles to enhance colloidal stability and the physical properties of the latex. Statistical copolymers of methacrylic acid and methyl methacrylate) were synthesized via catalytic chain transfer polymerization (CCTP) in emulsion. The vinyl‐terminated oligomers were in turn successfully utilized as chain transfer agents for the formation of diblock and pseudo triblock copolymers via sulfur‐free reversible addition–fragmentation chain transfer polymerization (SF‐RAFT). These copolymers were characterized using 1H NMR, size exclusion chromatography (SEC), dynamic light scattering (DLS), dynamic mechanical analysis (DMA), contact angle measurements and matrix‐assisted laser desorption/ionization time of flight mass spectroscopy (MALDI‐TOF‐MS) techniques. © 2019 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2019\ud \ud

Despite the growing role of simulation in procedural teaching, bronchoscopy training largely is experiential and occurs during patient care. The Accreditation Council for Graduate Medical Education sets a target of 100 bronchoscopies to be performed during pulmonary fellowship. Attending physicians must balance fellow autonomy with patient safety during these clinical teaching experiences. Few data on best practices for bronchoscopy teaching exist, and a better understanding of how bronchoscopy currently is supervised could allow for improvement in bronchoscopy teaching.How do attending bronchoscopists supervise bronchoscopy, and in particular, how do attendings balance fellow autonomy with patient safety?This was a focused ethnography conducted at a single center using audio recording of dialog between attendings and fellows during bronchoscopies, supplemented by observation of nonverbal teaching. Interviews with attending bronchoscopists and limited interviews of fellows also were recorded. Interviews were transcribed verbatim before analysis. We used constant comparative analysis to analyze data and qualitative research software to support data organization and thematic analysis. Education researchers from outside of pulmonary critical care joined the team to minimize bias.We observed seven attending bronchoscopists supervising eight bronchoscopies. We noted distinct teaching behaviors, classified into themes, which then were grouped into four supervisory styles of modelling, coaching, scaffolding, and fading. Observation and interviews illuminated that assessing fellow skill was one tool used to choose a style, and attendings moved between styles. Attendings accepted some, but not all, variation in both performing and supervising bronchoscopy.Attending pulmonologists used a range of teaching microskills as they moved between different supervisory styles and selectively accepted variation in practice. These distinct approaches may create well-rounded bronchoscopists by the end of fellowship training and should be studied further.

Objective There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID‐19 presenting during our initial local surge. Methods This is a multicenter, retrospective cohort study using data extracted from the electronic health records at 3 hospitals within a single health system from March 1, 2020 to June 1, 2020. Patients were included in the study if they presented to an ED and had laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during the study period. Data elements were extracted from the electronic health record electronically and by trained data abstractors and entered into a secure database. We used multivariable regression analysis to examine ED factors associated with the development of critical illness and mortality, with a primary outcome of ICU admission. Results A total of 330 patients with laboratory‐confirmed SARS‐CoV‐2 infection were admitted during the study period. Of these, 112 (34%) were admitted to the ICU. Among these patients, 20% were female, 50% were White, the median age was 61 (interquartile range [IQR], 52–72), and the median body mass index (BMI) was 28.1 (IQR, 24.3–35.1). On univariable analysis, a doubling of lactate dehydrogenase (LDH) (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.40–6.27) or high‐sensitivity C‐reactive protein (hsCRP; OR, 1.32; 95% CI, 1.11–1.57) above the reference range or elevated troponin (OR, 12.1; 95% CI, 1.20–121.8) were associated with ICU admission. After adjusting for age, sex, and BMI, LDH was the best predictor of ICU admission (OR, 3.54; 95% CI, 2.12–5.90). Of the patients, 15% required invasive mechanical ventilation during their hospital course, and in‐hospital mortality was 19%. Conclusions Nearly one‐third of ED patients who required hospitalization for COVID‐19 were admitted to the ICU, 15% received invasive mechanical ventilation, and 19% died. Most patients who were admitted from the ED were tachypneic with elevated inflammatory markers, and the following factors were associated with ICU admission: elevated hsCRP, LDH, and troponin as well as lower oxygen saturation and increased respiratory rate.

[2+2]-Photodimerisation of monothiomaleimides has been demonstrated on functionalised linear and brush-like polymers. In water/acetonitrile (95 : 5) mixtures the rate of reaction is accelerated significantly by irradiation of the thiomaleimide end group (λmax = 350 nm) with UV light, reaching full conversion within 10 minutes.

Efforts in the synthesis of macroporous polymers have mostly been directed towards the formation of stable high internal phase emulsions (HIPEs) from commercially available monomers, limiting their scope of application. Therefore, the development of simple synthetic approaches to access tailor-made macromonomers that can be used as precursors for the formation of HIPEs, allowing the design of new generations of polyHIPE materials with bespoke chemical and physical properties, is desirable in the search for new applications. In this work, cobalt(II) mediated catalytic chain transfer polymerisation (CCTP) is used to polymerise ethylene glycol dimethacrylate (EGDMA), producing multi vinyl-terminated branched EGDMA polymers with tuneable branching density and degree of unsaturation. These materials are subsequently implemented as macromonomer crosslinking agents for the formulation of HIPEs. The use of acrylate comonomers as propagation promoters is found to be essential and 2-ethylhexyl acrylate (EHA), isobornyl acrylate (IBOA) and 2-methoxyethyl acrylate (MEA) are investigated as comonomers in the formulations to both facilitate the photochemical curing of the HIPEs and to impart material properties to the products. The CCTP derived branched macromonomers are fully charaterised by GPC, 1H-NMR and MALDI–ToF spectroscopy. Scanning electron microscopy (SEM) is used to explore the morphology of the produced materials. Surface wettability experiments are conducted to evaluate the hydrophilicity of the polyHIPE surface. Compression tests are used to investigate the influence of the branching density of the CCTP macromonomers as well as the nature of comonomers on the mechanical properties of the materials.

Amphiphilic polymers have become key figures in the fields of pharmacology, medicine, agriculture and cosmetics. The use of reversible deactivation radical polymerisation (RDRP) techniques has allowed advances in the synthesis of amphiphilic polymers. However, the high price to performance ratio of these methods can limit their industrial application. Herein, poly(glycidyl methacrylate) polymers of varying molecular weights were first synthesised by catalytic chain transfer polymerisation (CCTP). Amphiphilic polymers were then prepared using a simple one-pot, post-polymerisation modification process involving Michael-thiol addition in the presence of a range of hydrophobic mercaptans, followed by ring-opening of the epoxide groups with ethanolamine using microwave-assisted synthesis. This procedure allows for the synthesis of fully functional polymers within 3 hours. A range of well-defined materials are prepared and characterised by GPC, NMR, FTIR, DLS, TGA, and TEM.

We report the use of MALDI-LID-ToF/ToF utilising the laser induced dissociation (LID) fragmentation technique, which has been almost exclusively applied to protein/peptide analysis to date. MALDI-LID-ToF/ToF is used as a powerful tool to give information of monomer distributions in synthetic co-poly(acrylates). Analysis of a range of poly(acrylate) homopolymers by LID have found slight improvement over CID, with less rearrangements in the poly(butyl acrylate) fragmentation and more backbone cleavages. Analysis of both block and statistical copolymers, when compared to homopolymer analogues, yield markedly different spectra which can be correlated to give some monomer sequence information, thus achieving a wealth of structural information from two samples which would otherwise be identical by single stage MALDI-ToF analysis. The determination of fragmentation pathways of polymers with varying end group lability and monomer structure has allowed for high-resolution microstructural determination at the block boundary, showing even small amounts of mixing at the block boundary.

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: There are approximately 290,000 in hospital cardiac arrests (IHCA) annually in the United States. Recent evidence suggests that post IHCA outcomes may be more related to post return of spontaneous circulation (ROSC) care than intra cardiac arrest resuscitation. The purpose of this study is to assess the effect of a post ROSC checklist on variability care after IHCA with ROSC. METHODS: We performed a retrospective analysis of inpatient adults with an IHCA with ROSC at Harborview Medical Center (HMC) between 1/1/2018-12/31/2019. Included patients had an ICHA on an acute care or intensive care unit (ICU), were over the age of 18, and not placed on extra corporeal membrane oxygenation. IHCA was defined as cardiopulmonary resuscitation delivered by healthcare personnel. Demographics, clinical variables, and process of care metrics were abstracted from the electronic medical record. We then developed a post ROSC checklist utilizing our retrospective data and expert opinion. The checklist was implemented at HMC in January 2020. We conducted a follow up analysis of post-ROSC care since checklist implementation between 1/1/2020-12/31/2020. Pre and post implementation results were compared. RESULTS: 125 IHCA were included in the pre implementation cohort and 47 were included in the post implementation cohort. The mean age of the pre implementation cohort was 55.1 versus 55.9 post implementation. Women comprised 36.8% in the pre implementation cohort and 37.0% in the post implementation cohort. The rate of obtaining an electrocardiogram within one hour of ROSC was 60.8% prior to checklist implementation, and 76.6% after implementation. The rate of obtaining a formal transthoracic echocardiogram within six hours of ROSC was 32.8% prior to checklist implementation, and 34.0% after implementation. The rate of physician documentation occurring within six hours of ROSC was 47.0% prior to checklist implementation, and 85.1% after implementation. The rate of documented notification of family within six hours of ROSC in 67.2% of cases prior to checklist implementation, and 80.8% after implementation. CONCLUSIONS: The introduction of a post ROSC checklist correlated with an increase in obtaining ECGs and completing documentation tasks after IHCA with ROSC at HMC. This study was limited by the small number patients included as well as being a single site study. Confounding circumstances in code blue management related to COVID-19 must be acknowledged. Further research is needed to assess the durability of these findings, and what impact this may have on post IHCA outcomes. CLINICAL IMPLICATIONS: While there will be differences in the management and evaluation of patients who suffer an IHCA, some interventions such as a timely ECG and documentation should be completed with little variance between patients. The use of a checklist decreased the rate of variance, by providing a cognitive aid to guide clinical decisions in a stressful scenario. The use of a post ROSC checklist has the potential to decrease variance in diagnostic and documentation tasks after IHCA. DISCLOSURES: No relevant relationships by David Carlbom, source=Web Response No relevant relationships by Stephen Ferraro, source=Web Response No relevant relationships by Vince Raikhel, source=Web Response No relevant relationships by Vera Schulte, source=Web Response No relevant relationships by James Town, source=Web Response

The effect UV irradiation on Cu(II)-based complexes with aliphatic amine ligands is investigated. Four aliphatic amines are used as ligands and Cu(II)Br2 as the metal source for the formation of catalyst complexes that can be used for the photoinduced Cu-RDRP of methyl acrylate. Different characterization techniques such as transient electronic absorption spectroscopy (TEAS), ultraviolet–visible (UV–Vis) spectroscopy, electrospray ionization time of flight mass spectrometry (ESI-ToF-MS) and cyclic voltammetry (CV) are applied in order to provide insights into the catalyst behaviour upon photo-irradiation. The excited-state dynamics, the electrochemical behaviour of the Cu(II)/Cu(I) redox couples and the detection of different species upon complexation of the ligand to the metal center (before and after UV irradiation) are further depicted in the quality of the obtained polymers.

Scalable methods of producing functional materials is of importance. Herein, we report the use of free radical copolymerisation of ω-unsaturated methacrylic macromonomers, as derived from catalytic chain transfer polymerisation (CCTP), with acrylic monomers in solution leading to block copolymers by varying the nature of the macromonomer. We demonstrate the effect that varying the molecular weight and ester side chain length of macromonomer from CCTP, has on the polymerisation leading to either graft or diblock copolymers. DOSY NMR, MALDI-ToF/ToF MS has allowed for the exploration of the extent to which varying the concentration of macromonomer has on the products formed. Importantly, during the successful synthesis of acrylic and methacrylic diblock copolymers with broad dispersities of each block, full consumption of the macromonomers was observed.

The lower limit of domain size resolution using microphase separation of short poly(acrylic acid) homopolymers equipped with a short fluorinated tail, posing as an antagonist 'A block' in pseudo AB block copolymers has been investigated. An alkyl halide initiator with a fluorocarbon chain was utilized as a first 'A block' in the synthesis of low molecular weight polymers (1400-4300 g mol -1) using photoinduced Cu(ii)-mediated polymerization allowing for very narrow dispersity. Poly(tert-butyl acrylate) was synthesized and subsequently deprotected to give very low degrees of polymerization (N), amphiphilic polymers with low dispersity (D = 1.06-1.13). By exploiting the high driving force for demixing and the well-defined 'block' sizes, we are able to control the nanostructure in terms of domain size (down to 3.4 nm full-pitch) and morphology. This work demonstrates the simple and highly controlled synthesis of polymers to push the boundaries of the smallest achievable domain sizes obtained from polymer self-assembly.

Tandem mass spectrometry is a powerful technique for investigating polymer architecture. However, in-depth studies of the technique for polymers is relatively lacking when compared to other areas of mass spectrometry (MS). This paper examines the use laser-induced dissociation and collision-induced dissociation (CID) in MALDI-LIFT-ToF/ToF experiments to compare the usage of the two techniques on a range of polymeric analytes. It is demonstrated that for samples with an energetically preferable fragmentation pathway, such as those with a functional group in the backbone or a labile end group, post source decay (PSD) provides a simplified spectra with an increased pathway selectivity due to its utilization of metastable decay. This makes PSD a preferable technique for polymer sequencing, especially in low-resolution time-of-flight techniques. Conversely, CID fragments less selectively, leading to higher intensity peaks from less favorable fragmentations. This makes CID more preferred for exact structural determination, such as finding the repeat unit structure.

Cystic fibrosis (CF) patients are at risk for life-threatening hemoptysis, sometimes necessitating bronchial arterial embolization (BAE). Spinal artery embolization and pulmonary infarction are commonly cited procedural risks, yet respiratory failure and death are underappreciated. We conducted a retrospective institutional review of our outcomes after BAE for hemoptysis in CF and present three cases highlighting this complication. From 2007 to 2015, 12 patients underwent 17 BAE procedures for hemoptysis at our institution. Three patients experienced respiratory failure and died within 3 months of BAE. Nonsurvivors had significantly lower baseline FEV 1 values than survivors (21.8% vs 52.6%, P

Background The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. Objective We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. Methods We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound. Results Participants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training (P 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups. Conclusions Residents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates.

Why should we let science teachers have all the fun? Throughout our teaching careers, we have worked with science teachers, experiencing physics and chemistry data modeling activities as part of the science curriculum. We have observed students learning mathematical content in their science classes by collecting and analyzing real data to develop a conceptual understanding of various functional relationships. We have also worked with science teachers to bridge connections between physics and chemistry topics when working with the fi ve families of functions: linear, quadratic, trigonometric, inverse, and exponential. As math teachers, one thing has become clear: Science teachers and students are having fun. What offends us is toward Algebra and Slope

Cystic fibrosis (CF) patients are at risk for life-threatening hemoptysis, sometimes necessitating bronchial arterial embolization (BAE). Spinal artery embolization and pulmonary infarction are commonly cited procedural risks, yet respiratory failure and death are underappreciated. We conducted a retrospective institutional review of our outcomes after BAE for hemoptysis in CF and present three cases highlighting this complication. From 2007 to 2015, 12 patients underwent 17 BAE procedures for hemoptysis at our institution. Three patients experienced respiratory failure and died within 3 months of BAE. Nonsurvivors had significantly lower baseline FEV

The decision to admit a patient to the ICU is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests.In this observational study using data collected between 2009 and 2011, rates of ICU readmission and ward cardiac arrest were determined per 12-hour shift. The relationship between these rates and the number of available ICU beds at the start of each shift (accounting for census and nursing capacity) was investigated. Grouped logistic regression was used to adjust for potential confounders.Five specialized adult ICUs comprising 63 adult ICU beds in an academic medical center.Any patient admitted to a non-ICU inpatient unit was counted in the ward census and considered at risk for ward cardiac arrest. Patients discharged from an ICU were considered at risk for ICU readmission.None.Data were available for 2,086 of 2,190 shifts. The odds of ICU readmission increased with each decrease in the overall number of available ICU beds (odds ratio = 1.06; 95% CI, 1.00-1.12; p = 0.03), with a similar but not statistically significant association demonstrated in ward cardiac arrest rate (odds ratio = 1.06; 95% CI, 0.98-1.14; p = 0.16). In subgroup analysis, the odds of ward cardiac arrest increased with each decrease in the number of medical ICU beds available (odds ratio = 1.26; 95% CI, 1.06-1.49; p = 0.01).Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes, and flexible critical care resources may be needed when demand is high.